The pattern of neurocritical disorders in multicenter in Khartoum State November 2020 to January 2021

Abstract Background Neurocritical care is a growing subspecialty. It concerns with the management of life‐threatening neurological disorders. There is limited information regarding epidemiological data, disease characteristics, variability of clinical care, and in‐hospital mortality of neurocritical patients worldwide. Objectives To study the pattern of neurocritical disorders in intensive care units. Methodology This prospective observational study was conducted on neurocritical patients who were admitted to four intensive care units of major hospitals in Khartoum state during the period from November 2020 to January 2021. Results Seventy‐two neurocritical patients were included in this study, 40 (55.6%) were males and 32(44.4%) were females. Twenty‐three (31.9%) patients were with stroke, 12 (16.7%) with encephalitis, 9 (12.5%) with status epilepticus, 6 (8.3%) with Guillain Barre syndrome, and 4(5.6%) with Myasthenia Gravis (MG). Twenty‐three patients (39.9%) needed mechanical ventilation (MV), which was the major indication for intensive care unit admission. Conclusion Stroke was the dominant diagnostic pattern requiring intensive care unit admission. Mechanical ventilation was the major indication for admission. Establishing specialized neurocritical intensive care units is highly recommended.

erative diseases and encephalopathy in 3%, cerebral neoplasm in 3%, and intoxications in 3%. The remaining 63 patients were patients outsourced from general ICUs due to space limitations as well as patients temporarily monitored after neuroradiological procedures (Kiphuth et al., 2010). A very big amazing study named Point Prevalence In Neurocritical Care (PRINCE) was achieved in two parts sponsored by the Worldwide Organization of Neurocritical Care . PRINCE was the first study to evaluate the care and patterns of neurocritical patients worldwide via performing a global survey of outcomes of neurocritical care patients. The findings concerned with the pattern of neurocritical care conditions were as follows: the most common primary reason for ICU admission was neurological monitoring (88%), and the majority of patients (42.6%) were admitted from the emergency department. The most frequent primary neurological diagnosis was SAH followed by ICH, subdural hematoma, and severe TBI (Venkatasubba Rao et al., 2020).

General objective
To study the pattern of neurocritical disorders in intensive care units.

Specific objectives
To identify the types of neurological disorders admitted in ICUs. To highlight neurological manifestations in ICU patients who required neurological consultation.

Study design
It is a prospective cross-sectional descriptive study.

ICU in Soba University Hospital
Omdurman Hospital is one of the oldest hospitals in Sudan. It is located in Omdurman city. It is the largest hospital in the city that received patients from different states of Sudan with full-day services.
The intensive care unit of the hospital has a capacity for 10 patients.
Bashir Hospital is a full-day university hospital. It is located in the Southern part of Khartoum city, the capital of Sudan. The intensive care unit of the hospital has a capacity of six beds.
Ibrahim Malik Hospital is located in the middle of Khartoum city. The intensive care unit of the hospital has a capacity of 6 beds.
Soba Hospital is in Khartoum city. The intensive care of the hospital has capacity of six beds.

Study duration
The study was conducted in the period from November 2020 to January 2021.

Study population
All neurocritical disorders were admitted to the ICU in addition to medical ICU patients who required neurologist consultations during their ICU stay.

Data collection tools and methods
The data were collected by the principal investigator. Two visits per week were conducted. A predesigned questionnaire was used to collect the data after reviewing the history, performing a clinical examination, checking records, looking for investigations and discussing with the physician in charge.

Plan of data analysis
Data were processed by using the computerized program Statistical Package for Social Sciences (SPSS), version 23.

Ethical consideration
Sudan Medical Specialization Board (SMSB) ethical committee approval was obtained. Neurological indications for MV were as follows: the failure of central regulation of respiration in 5 (6.9%) patients, inability to protect airway in 6 (8.3%), GCS less than 9 in 27 (37.5%), and impending respi- in 2 patients, and confirmation of brain death in 1 patient. Causes of disturbed LOC in consulted patients were found to be anoxic brain injury in five patients and metabolic cause in six patients. Delayed ICU admission was assumed in 13 patients (18.1%), which was considered to be due to the medical side in 6 patients and patient side in 7. The duration of ICU stay was as follows: less than 48 h for 6 (8.3%) patients, 3-6 days for 23 (31.9%), 1-8 weeks for 28 (38.9%), and 14 (19.4%) stayed more than 8 weeks. Duration on MV was as follows: less than 48 h for 7 patients, 3-6 days for 13 patients, 1-8 weeks for 23 patients, and 3 patients needed more than 8 weeks MV.

DISCUSSION
This study reflected the situation in Khartoum, the capital of Sudan, which has a similar practice to what is going on in most of the developing countries in which the general ICU is the main facility for neurocritical care. Starting with the distribution of the population by gender and age, this study showed no difference when compared with a large study , which was conducted by The Worldwide Organization of Neurocritical Care (Backhaus et al., 2015 seizures as well as the types' diagnosis in which stroke was found to be the major types of condition admitted to ICU with slight variation in the studies that were conducted in the countries with established comprehensive stroke units system, the facts that were demonstrated by Howard and Kullman (2003). Encephalitis was found to have a higher burden upon ICU services when compared with the literature review . This is expected in the tropics, but in 41.8% of these cases, the etiology was not confirmed which might be due to the unavailability of the facilities for full workup of viral and autoimmune encephalitis. The indications for ICU admission were compatible with